This questionnaire helped to identify a group at high risk for melanoma. Furthermore, good agreement was found when the patient's risk scores were compared with results of the clinical skin examination. This risk score is potentially useful in targeting primary and secondary prevention of melanoma through general practice.

The aim of this study was to audit all malignant melanomas confirmed histologically in the Scarborough Health District over six years, prompted by the continuing rise in incidence rate nationally and relatively high number of malignant melanomas excised by general practitioners (GPs) in this area. A total of 157 malignant melanomas were diagnosed (60% from females and 40% from males) over the six years; primary excisions being carried out by GPs (37%) and hospital specialists (63%). The clinical diagnosis of malignant melanoma was made in 9% of GP cases and 35% of the hospital specialist cases. However another 45.5% of GP cases, and 38% of hospital specialist cases were regarded as suspicious pigmented lesions clinically. The histological diagnosis was of superficial spreading malignant melanoma in 72% of the GP and 69% of the hospital specialist cases. Most of the GP melanomas were excised with a lateral margin of 2 mm or less (71%); around half of the hospital excisions had a margin of over 2 mm (49%). Most melanomas were 2 mm or less in depth (Breslow depth) in both the GP (81%) and hospital specialist (75%) series. Over the six year period (1993-98) the incidence of malignant melanomas has continued to rise, but Breslow depth at diagnosis has not changed significantly. It is therefore important to continue with early recognition of this condition by GPs in the first instance, reduction in its incidence being the long term goal. During five years of the study there were only 67 lesions thought clinically to be malignant melanoma (26 GP and 41 hospital specialist cases), but which proved to be benign histologically. (Postgrad Med J 2000;76:295-298)

SUMMARY A review of the primary tumours of the nervous system encountered over the past 16 years from the population of the west of Scotland uncovered only three tumours in which remote extracranial metastases had developed. In all three, there had been surgical intervention before the appearance of metastases. The findings in these patients are compared with those in other published accounts of this unusual complication. Primary brain tumours probably account for less than I % of all deaths, and the vast majority of these kill as a result of their intracranial effects, in contrast to most malignant tumours elsewhere in the body which are lethal largely as a result of metastases. However, it is now well recognised that primary intracranial tumours can give rise to extracranial metastases (Drachman et al

A prospective survey of 3105 adults in 16 randomly selected group practices was conducted to test whether individuals with a personal experience, family history, or other contact with malignant melanoma display more knowledge and appropriate behavior with regard to melanomas and sun exposure than those with no such experience. Although patients with previous contact with the condition were more likely to check for moles, were more aware of the significance of changes in the shape of moles, and were more aware of the necessity for prompt treatment, they were not more knowledgeable about other important signs or more likely to protect themselves from sun exposure. Direct experience or contact with melanoma appeared to have some positive effects on knowledge, but there is no room for complacency for those at increased risk or those treating them. Both primary and secondary prevention for people who are vulnerable could be undertaken in primary care.

1087 stricture in the sigmoid colon. At laparotomy a large carcinoma was found in the sigmoid colon and a second similar lesion was found in the transverse colon. While resecting the large sigmoid growth a portion of the right ureter was removed. A primary colonic anastomosis was performed and covered by a double-barrelled colostomy fashioned in the transverse colon after resection of the second lesion. Urinary leakage occurred soon after operation and an intravenous pyelogram confirmed a leak from the right ureter. Urinary leakage continued postoperatively, and because of the poor general health of the patient renal embolisation was considered. The left femoral artery was catheterised under local anaesthesia and a right renal arteriogram was obtained. Two, or most probably three, renal arteries were seen supplying the right kidney and embolisation of two of these was achieved with Gelfoam and wire springs. Urinary leakage was considerably diminished subsequently. A further intravenous pyelogram showed minimal delayed excretion from the right kidney, suggesting perfusion from a small accessory artery. Leakage ceased completely after two months. CommentUreteric damage may occur during resection of any extensive colonic or pelvic growth and if it is recognised at the time primary repair or transureteroureterostomy, reimplantation into the bladder and nephrectomy are the procedures of choice.' 2 Ureteric ligation is simpler, but there is a risk of subsequent infection and leakage. If this occurs, or if the injury is not recognised at the time, the surgeon is faced with the prospect of further surgery in the postoperative period if the leak does not stop spontaneously. Renal embolisation is an alternative in the elderly, poor-risk patient not fit for further surgery, provided contralateral renal function is adequate. This can be assessed by intravenous urography or divided renal function tests with a renal scan. Leakage of urine by vesicoureteric reflux must also be excluded.In one patient the leakage ceased dramatically, and was reduced in the second patient, though it did not stop completely for several weeks owing to a small aberrant renal artery. Both patients left hospital after a simple procedure and neither experienced any appreciable loin pain. Transrenal ureteric embolisation with direct closure of the defect has also been described.3Therapeutic embolisation is now widely practised by radiologists for several indications including renal tumours, hepatic metastases, bleeding oesophageal varices, and complicated arteriovenous fistulae.4 In certain poor-risk patients it would appear to be useful for postoperative ureteric leakage. Although amyloidosis may be localised to the central nervous system, and localised disease of the gasserian ganglion2 has been described, we have been unable to find previous reports of localised amyloid affecting the spinal extradural space. Case reportA 76-year-old woman was admitted with a six-month history of increased weakness and paraesthesis of the legs with nocturia and incon...